Provider Demographics
NPI:1124079397
Name:JOHANSEN, RIKKE (DC)
Entity type:Individual
Prefix:DR
First Name:RIKKE
Middle Name:
Last Name:JOHANSEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 COWPER ST
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301-1808
Mailing Address - Country:US
Mailing Address - Phone:650-484-0110
Mailing Address - Fax:650-644-0110
Practice Address - Street 1:609 COWPER ST
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-1808
Practice Address - Country:US
Practice Address - Phone:650-484-0110
Practice Address - Fax:650-644-0110
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-13
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC22727111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU50305Medicare UPIN